51
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Song H, Lahood N, Mostaghimi A. Intravenous immunoglobulin as adjunct therapy for refractory pyoderma gangrenosum: systematic review of cases and case series. Br J Dermatol 2018; 178:363-368. [PMID: 28742926 DOI: 10.1111/bjd.15850] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2017] [Indexed: 11/30/2022]
Abstract
Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis. Treatment regimens for refractory cases are nonstandardized. Intravenous immunoglobulin (IVIG) is an emerging treatment with reported success, but the efficacy of IVIG for PG is unknown. In this systematic review of cases and case series, we assessed the efficacy of IVIG for the treatment of PG, as observed at our institution and reported in the literature. A retrospective chart review at two tertiary care hospitals between 2000 and 2015, and literature searches in PubMed/MEDLINE, EMBASE and Web of Science from all years were conducted. In total, there were 49 patients, including 43 patients from 26 articles and six institutional cases. There was complete or partial response in 43 (88%) patients and complete response in 26 (53%) patients. The mean time to initial response to treatment and treatment length were 3·5 (SD 3·3) weeks and 5·9 (SD 7·8) months, respectively. On average, 2·6 treatments had been trialled before IVIG initiation. IVIG was administered with systemic steroids in 43 (88%) cases. Mild adverse events, especially nausea and headache, were reported in 12 (24·5%) patients. Our systematic review suggests a potential role for IVIG as adjuvant therapy for refractory PG. Prospective clinical trials testing the efficacy of IVIG for refractory PG are needed to validate these findings.
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Affiliation(s)
- H Song
- Harvard Medical School, Boston, MA, U.S.A
| | - N Lahood
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, U.S.A
| | - A Mostaghimi
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, U.S.A.,Department of Dermatology, Brigham and Women's Hospital, 75 Francis Street, PBB-B 421, Boston, MA, 02115, U.S.A
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Kolios AGA, Hafner J, Luder C, Guenova E, Kerl K, Kempf W, Nilsson J, French LE, Cozzio A. Comparison of pyoderma gangrenosum and Martorell hypertensive ischaemic leg ulcer in a Swiss cohort. Br J Dermatol 2018; 178:e125-e126. [PMID: 28832960 DOI: 10.1111/bjd.15901] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- A G A Kolios
- Department of Dermatology, Zürich University Hospital, Zürich, Switzerland.,Department of Immunology, Zürich University Hospital, Zürich, Switzerland
| | - J Hafner
- Department of Dermatology, Zürich University Hospital, Zürich, Switzerland
| | - C Luder
- Department of Dermatology, Zürich University Hospital, Zürich, Switzerland
| | - E Guenova
- Department of Dermatology, Zürich University Hospital, Zürich, Switzerland.,Department of Dermatology, Venerology and Allergology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - K Kerl
- Department of Dermatology, Zürich University Hospital, Zürich, Switzerland
| | - W Kempf
- Department of Dermatology, Zürich University Hospital, Zürich, Switzerland.,Kempf und Pfaltz Histologische Diagnostik, Zürich, Switzerland
| | - J Nilsson
- Department of Immunology, Zürich University Hospital, Zürich, Switzerland
| | - L E French
- Department of Dermatology, Zürich University Hospital, Zürich, Switzerland
| | - A Cozzio
- Department of Dermatology, Venerology and Allergology, Kantonsspital St Gallen, St Gallen, Switzerland
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53
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Efe İris N, Diz-Küçükkaya R, Arat M, Eriş Z. Bullous Pyoderma Gangrenosum in a Patient with Acute Myelogenous Leukemia as a Pathergic Reaction after Bone Marrow Biopsy. Turk J Haematol 2017; 34:350-351. [PMID: 27313098 PMCID: PMC5774376 DOI: 10.4274/tjh.2016.0096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Nur Efe İris
- İstanbul Bilim University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, İstanbul, Turkey,Avrupa Florence Nightingale Hospital, Clinic of Infectious Diseases and Clinical Microbiology, İstanbul, Turkey
| | - Reyhan Diz-Küçükkaya
- İstanbul Bilim University Faculty of Medicine, Department of Internal Medicine Division of Hematology, İstanbul, Turkey
| | - Mutlu Arat
- İstanbul Bilim University Faculty of Medicine, Department of Internal Medicine Division of Hematology, İstanbul, Turkey
| | - Zahide Eriş
- İstanbul Bilim University Faculty of Medicine, Department of Dermatology, İstanbul, Turkey
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54
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Affiliation(s)
- M G Berry
- St Andrew's Centre for Plastic and Burn Surgery, Broomfield Hospital, Chelmsford, Essex CM1 7ET, UK.
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55
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Ebrad S, Severyns M, Benzakour A, Roze B, Derancourt C, Odri GA, Rouvillain JL. Pyoderma gangrenosum after orthopaedic or traumatologic surgery: a systematic revue of the literature. INTERNATIONAL ORTHOPAEDICS 2017; 42:239-245. [PMID: 29119297 DOI: 10.1007/s00264-017-3672-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 10/16/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterised by a painful ulceration mimicking infection of the operative site. To this day, there is still no general agreement on the medical and surgical treatment of PG. This systematic review of the literature aims to summarise recent studies about post-operative PG in orthopaedic surgery to improve its medical and surgical management. METHOD In April 2017, we carried out an exhaustive review of the literature in MEDLINE, PubMed and Cochrane databases. Key words were pyoderma gangrenosum, orthopaedic surgery, and surgical wound infection. We identified 183 articles. After excluding articles reporting idiopathic PG, cases secondary to non-orthopaedic surgery, and cases about other subtypes of dermatosis, 30 studies were identified. We only included articles reporting PG after orthopaedic or trauma surgery. RESULTS Thirty-one cases of PG have been reported, 58% (18) of which were in women, whose mean age was 56.5 years. Clinical signs were constant, the most frequently affected site was lower limbs [77.4% (24)] and delay of symptom onset was two to 17 days. Systemic corticosteroid therapy was systematic, polyvalent immunoglobulins were used in two cases and immunosuppressive drugs in one. Negative pressure therapy was used in seven cases and hyperbaric oxygen in three. DISCUSSION Delayed diagnosis leads to one or more surgical revisions, which could have been avoided by using early and adapted medical treatment. Early onset of a painful and infected ulcer at the operating site in a patient at risk of PG is an indicator that dermatologist advice is recommended before surgical debridement. Surgical revision, outside the inflammatory phase and/or covered by a systemic corticosteroid therapy, does not lead to PG relapse. LEVEL OF EVIDENCE IV: Systematic revue of the literature.
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Affiliation(s)
- Stephan Ebrad
- Orthopaedic and Traumatologic Department, Military Hospital Robert Picqué, 351 route de Toulouse, 33140, Villenave d'Ornon, France
| | - Mathieu Severyns
- Orthopaedic and Traumatologic Department, La Meynard University Hospital, CS 90632, 97261, Fort-de-France, Martinique.
| | - Ahmed Benzakour
- Orthopaedic and Traumatologic Department, La Meynard University Hospital, CS 90632, 97261, Fort-de-France, Martinique
| | - Benoit Roze
- Department of Infectiology, La Meynard University Hospital, CS 90632, 97261, Fort-de-France, Martinique
| | - Christian Derancourt
- Department of Dermatology, La Meynard University Hospital, CS 90632, 97261, Fort-de-France, Martinique
| | - Guillaume-Anthony Odri
- Orthopaedic and Traumatologic Department, Lariboisière University Hospital, rue Ambroise Paré, 75010, Paris, France
| | - Jean-Louis Rouvillain
- Orthopaedic and Traumatologic Department, La Meynard University Hospital, CS 90632, 97261, Fort-de-France, Martinique
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Postoperative Pyoderma Gangrenosum in Children: The Case Report of a 13-Year-Old Boy With Pyoderma Gangrenosum After Hip Reconstruction Surgery and a Review of the Literature. J Pediatr Orthop 2017; 37:e379-e383. [PMID: 28719544 DOI: 10.1097/bpo.0000000000000952] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Postoperative pyoderma gangrenosum (PG) is a neutrophilic dermatosis and pathergic reaction at surgical sites. Reports of children with postoperative PG are rare in the literature. METHODS We report the case of a 13-year-old boy without any known preexisting illnesses, who developed severe systemic response and wound deterioration after elective hip reconstruction surgery. The working diagnosis of necrotizing fasciitis was later determined to be postoperative PG. RESULTS The patient was successfully treated by the systemic application of corticosteroids. CONCLUSIONS Postoperative PG is a very rare complication after surgery, especially in children. If mistaken for necrotizing fasciitis, it can substantially mutilate a patient because PG is worsened by surgical debridement. It can be treated successfully only by corticosteroids and other immunosuppressive drugs. LEVEL OF EVIDENCE Level IV-this is a case report.
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58
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Chua-Aguilera CJ, Möller B, Yawalkar N. Skin Manifestations of Rheumatoid Arthritis, Juvenile Idiopathic Arthritis, and Spondyloarthritides. Clin Rev Allergy Immunol 2017; 53:371-393. [DOI: 10.1007/s12016-017-8632-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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59
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Marzano AV, Borghi A, Wallach D, Cugno M. A Comprehensive Review of Neutrophilic Diseases. Clin Rev Allergy Immunol 2017; 54:114-130. [DOI: 10.1007/s12016-017-8621-8] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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60
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Vallini V, Andreini R, Bonadio A. Pyoderma Gangrenosum: A Current Problem as Much as an Unknown One. INT J LOW EXTR WOUND 2017; 16:191-201. [DOI: 10.1177/1534734617710980] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pyoderma gangrenosum (PG) is a rare neutrophilic inflammatory skin disease, characterized by recurrent skin ulcers, which in almost 50% of cases are associated with systemic autoimmune disorders, including rheumatoid arthritis, chronic hepatitis, inflammatory bowel disease, paraproteinemias and hematological malignancies. A systematic search of literature for PG was carried out using the PubMed, Embase, and Google Scholar databases for the purpose of this review and 2780 articles were retrieved up to February 2017. Inflammation represents the predominant aspect of the disease, but its pathophysiological mechanisms are not completely clear yet, since there are many studies showing only one or more isolated findings of the disease. The goal of PG treatment is to reduce inflammation in order to promote ulcer healing by minimizing side effects of therapy. Several systemic and local treatments are available, but the lack of large randomized double-blind studies results in an absence of a uniform therapeutic standard: thus, more clinical studies are required in order to make head-to-head comparisons between combination and single-drug therapies and to identify specific combination therapies for distinctive clinical patterns of PG.
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Affiliation(s)
- Valerio Vallini
- Ospedale Santa Maria Maddalena–Volterra, Azienda Usl Nordovest, Toscana, Italy
| | - Roberto Andreini
- Ospedale Santa Maria Maddalena–Volterra, Azienda Usl Nordovest, Toscana, Italy
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61
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Abstract
Pyoderma gangrenosum (PG) is an ulcerating, neutrophilic dermatosis of unknown etiology. Clinical appearance is characterized by sudden onset of sterile pustules that rapidly develop into very painful ulcerations with violaceous, undermined borders. Due to the lack of specific diagnostic and therapeutic markers, PG is a diagnosis of exclusion. An association with further diseases such as chronic inflammatory bowel disease, rheumatoid arthritis, diabetes, neoplasms, or metabolic syndrome exists in over 50 % of cases. Treatment of PG consists of suppression of inflammatory disease activity, treatment of associated morbidities, promotion of wound healing, and pain relief. Recommended first-line treatment consists of systemic glucocorticosteroids and additional or alternatively cyclosporine. A controlled trial on infliximab in PG points to efficacy of TNF-alpha antagonists. Due to chronicity, frequent recurrences, and often complicated courses, treatment with good tolerability is important.
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Affiliation(s)
- K Herberger
- Comprehensive Wound Center (CWC), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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62
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Bullous Pyoderma Gangrenosum as the Presenting Sign of Acute Myeloid Leukemia in a Child. J Pediatr Hematol Oncol 2017; 39:312-313. [PMID: 28267091 DOI: 10.1097/mph.0000000000000796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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63
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Vacas AS, Torre AC, Bollea-Garlatti ML, Warley F, Galimberti RL. Pyoderma gangrenosum: clinical characteristics, associated diseases, and responses to treatment in a retrospective cohort study of 31 patients. Int J Dermatol 2017; 56:386-391. [DOI: 10.1111/ijd.13591] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 01/25/2017] [Accepted: 08/02/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Aldana S. Vacas
- Department of Dermatology; Hospital Italiano de Buenos Aires; Buenos Aires Argentina
| | - Ana C. Torre
- Department of Dermatology; Hospital Italiano de Buenos Aires; Buenos Aires Argentina
| | | | - Fernando Warley
- Department of Internal Medicine, Research Unit; Hospital Italiano de Buenos Aires; Buenos Aires Argentina
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64
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Bissonnette C, Kauzman A, Mainville GN. Oral Pyoderma Gangrenosum: Diagnosis, Treatment and Challenges: A Systematic Review. Head Neck Pathol 2017; 11:427-441. [PMID: 28275955 PMCID: PMC5677063 DOI: 10.1007/s12105-017-0804-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/20/2017] [Indexed: 12/24/2022]
Abstract
Pyoderma gangrenosum (PG) is a distinctive ulcerative skin disorder of unknown etiology, associated with an underlying systemic disease in up to 70% of cases. The condition is characterized by the appearance of one or more necrotic ulcers with a ragged undermined violaceous border and surrounding erythema. Lesions are often initiated by minor trauma. The condition can affect any anatomical site, however the head and neck are rarely involved. Although the oral cavity is subject to recurrent minor trauma through everyday activities such as mastication and oral hygiene, as well as during dental treatment, oral lesions appear to be extremely rare. In an effort to provide a detailed explanation of the oral manifestations of PG, a systematic search was conducted using medical databases. A total of 20 cases of PG with oral involvement were reported in the English and French literature. The objectives of this article are to present the pertinent diagnostic criteria and to discuss the differential diagnosis and therapeutic modalities.
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Affiliation(s)
- Caroline Bissonnette
- Resident, Multidisciplinary Residency Program, Faculty of Dentistry, Universite de Montreal, Montreal, QC Canada
| | - Adel Kauzman
- Oral and Maxillofacial Pathologist, Department of Stomatology, Faculty of Dentistry, Universite de Montreal, Montreal, QC Canada
| | - Gisele N. Mainville
- Oral and Maxillofacial Pathologist, Department of Stomatology, Faculty of Dentistry, Universite de Montreal, Montreal, QC Canada
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65
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Kechichian E, Haber R, Mourad N, El Khoury R, Jabbour S, Tomb R. Pediatric pyoderma gangrenosum: a systematic review and update. Int J Dermatol 2017; 56:486-495. [PMID: 28233293 DOI: 10.1111/ijd.13584] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/11/2017] [Accepted: 01/11/2017] [Indexed: 12/21/2022]
Abstract
Pyoderma gangrenosum (PG) is a sterile neutrophilic disorder that rarely affects children. Clinical, epidemiological, and therapeutic data on pediatric PG is poor as there are many newly reported associated diseases and drugs. This paper aims to review all recent available data on pediatric PG. A systematic review of the literature was conducted using Embase, Medline, and Cochrane databases. A total of 132 articles were included in the review. The most commonly reported underlying diseases in pediatric PG are inflammatory bowel diseases followed by hematologic disorders, vasculitis, immune deficiencies and Pyogenic Arthritis, Pyoderma gangrenosum and Acne (PAPA) syndrome. More than half of the cases occur with no underlying disease. The most frequently reported clinical presentation is multiple disseminated ulcers. Treatment should be tailored according to the underlying etiology. It includes systemic steroids, corticosteroid sparing agents such as dapsone and cyclosporine, and TNF-alpha inhibitors such as adalimumab and infliximab. Response to treatment is high with cure rates reaching 90%. A high index of suspicion and a thorough workup are mandatory in the management of pediatric PG.
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Affiliation(s)
- Elio Kechichian
- Department of Dermatology, Hotel Dieu de France University Hospital, Beirut, Lebanon.,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Roger Haber
- Department of Dermatology, Hotel Dieu de France University Hospital, Beirut, Lebanon.,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Nadim Mourad
- Department of Dermatology, Hotel Dieu de France University Hospital, Beirut, Lebanon.,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Rana El Khoury
- Department of Dermatology, Hotel Dieu de France University Hospital, Beirut, Lebanon.,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Samer Jabbour
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Plastic and Reconstructive Surgery, Hotel Dieu de France University Hospital, Beirut, Lebanon
| | - Roland Tomb
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Chief of Department of Dermatology, Hotel Dieu de France University Hospital, Beirut, Lebanon
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66
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Fujikawa T, Suzuka T. Rare case of pyoderma gangrenosum originating in the spleen. BMJ Case Rep 2017; 2017:bcr-2016-216909. [PMID: 28213550 DOI: 10.1136/bcr-2016-216909] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Tatsuya Fujikawa
- Mitoyo General Hospital, Kan-onji, Japan.,Seikeikai Hospital, Sakai, Japan
| | - Takayasu Suzuka
- Depertment of Internal Medicine (I), Osaka Medical College, Takatsuki, Japan
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67
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Bullous Pyoderma Gangrenosum With Subungual Involvement Associated With Ulcerative Colitis. Am J Dermatopathol 2016; 39:476-478. [PMID: 27893467 DOI: 10.1097/dad.0000000000000801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Pyoderma gangrenosum (PG) is a rare inflammatory and ulcerative skin disease of unknown etiology characterized by neutrophilic infiltration of the dermis, mainly affecting the lower extremities. Bullous PG is a rare variant of this disease, usually associated with hematologic disorders. Here, we report a case of pathergy-positive bullous PG with subungual involvement associated with ulcerative colitis.
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68
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Pediatric pyoderma gangrenosum: is it just big wounds on little adults? J Surg Res 2016; 206:113-117. [DOI: 10.1016/j.jss.2016.06.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 04/19/2016] [Accepted: 06/09/2016] [Indexed: 11/20/2022]
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69
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Abstract
Background: Pyoderma gangrenosum is a necrotizing skin disorder of unknown cause. Treatment of pyoderma gangrenosum usually entails medical treatments. Surgical treatment is generally not successful. Objective: Two patients with pyoderma gangrenosum of their lower extremities are presented. The application and utility of microvascular free flap coverage of their ulcers is discussed. Results: Both patients achieved successful healing with microvascular free flaps. Conclusion: Microvascular free flap coverage may be a surgical treatment option for selected patients with pyoderma gangrenosum.
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Affiliation(s)
- Dale A. Classen
- Division of Plastic Surgery, Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Chris Thomson
- Division of Plastic Surgery, Royal University Hospital, Saskatoon, Saskatchewan, Canada
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70
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Papadopoulos AJ, Schwartz RA, Kapila R, Samady JA, Ruszczak Z, Rao BK, Lambert WC. Pyoderma Vegetans. J Cutan Med Surg 2016. [DOI: 10.1177/120347540100500306] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Pyoderma vegetans is a rare condition that is clinically characterized by large verrucous plaques with elevated borders and multiple pustules. The etiology of this disorder remains unknown. Objectives: We describe a 24-year-old woman with rapidly evolving pyoderma vegetans. Our patient had the unique additional findings of a highly elevated serum IgE level and a history of hidradenitis suppurativa. Conclusions: Pyoderma vegetans is diagnosed on clinical and histological criteria. Differentiation must be made from disorders such as pyoderma gangrenosum, Sweet's syndrome, and deep fungal infections. We illustrate a case of pyoderma vegetans and review the literature on this rare disorder. Clinical and histological criteria for diagnosis are presented, as well as differentiation from some mimicking disorders.
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Affiliation(s)
| | - Robert A. Schwartz
- Dermatology, New Jersey Medical School, Newark, New Jersey
- Pathology, New Jersey Medical School, Newark, New Jersey
| | - Rajendra Kapila
- Infectious Diseases, New Jersey Medical School, Newark, New Jersey
| | | | | | | | - W. Clark Lambert
- Dermatology, New Jersey Medical School, Newark, New Jersey
- Pathology, New Jersey Medical School, Newark, New Jersey
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71
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Nybaek H, Olsen AG, Karlsmark T, Jemec GBE. Topical Therapy for Peristomal Pyoderma Gangrenosum. J Cutan Med Surg 2016. [DOI: 10.1177/120347540400800403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Pyoderma gangrenosum (PG) is an uncommon condition. Literature on the management of peristomal PG (PPG) is sparse. In the absence of randomized controlled trials the reporting of case series is potentially helpful to the management of this uncommon disease. Objective: In this study we report our experience with topical corticosteroid therapy for 14 consecutive cases of PPG. Methods: A clinical diagnosis PPG was made by a trained dermatologist using the appropriate investigations where necessary. Results: The majority of the cases presented were managed with simple topical corticosteroids, occasionally in combination with a change of dressing. In 8/14 (57%) cases ulcer resolution was achieved within 3 months with topical treatment alone or topical treatment plus a change of dressing to a silicone-based product applied directly to the wound under the normal base plate of the stoma bag. Conclusion: Our experience suggests that a significant proportion of PPG can be managed by topical treatment alone. The simple topical treatment allows the patient to continue use of stoma care products while minimizing the potential for side effects.
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Affiliation(s)
- Hanne Nybaek
- Division of Dermatology, Department of Medicine, Roskilde Hospital, Roskilde, Denmark
| | - A. G. Olsen
- Stoma Clinic, Department of Surgery, Roskilde County Hospital in Køge, Køge, Denmark
| | - T. Karlsmark
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - G. B. E. Jemec
- Division of Dermatology, Department of Medicine, Roskilde Hospital, Roskilde, Denmark
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72
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Abstract
Background: Pyoderma gangrenosum (PG) is an uncommon condition that is associated with a systemic disease in 50% of patients. The condition may be associated with a monoclonal gammopathy, usually of the IgA type. It is rare for PG to be associated with multiple myeloma. Observations: We report the case of an 83-year-old man with PG associated with an IgA myeloma. The myeloma was discovered after the diagnosis of PG had been made. This is the 22nd case of multiple myeloma associated with PG, and only the 14th case of PG with an IgA myeloma. Conclusions: We should be aware of the potential association of multiple myeloma with PG, and consider doing a serum protein electrophoresis in the evaluation of patients with PG.
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Affiliation(s)
- J. Mark Jackson
- Division of Dermatology, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| | - Jeffrey P. Collen
- Division of Dermatology, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky
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73
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Pechman DM, Bonati LM, Harrington MD. Painful Anterior Chest Wall Mass, Compatible With Abscess on Computed Tomography and Possible Osteomyelitis in a Man With Ulcerative Colitis. Gastroenterology 2016; 151:398-9. [PMID: 27485650 DOI: 10.1053/j.gastro.2016.04.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 04/12/2016] [Accepted: 04/29/2016] [Indexed: 12/02/2022]
Affiliation(s)
- David M Pechman
- Department of Surgery, Mount Sinai Beth Israel, New York, New York
| | | | - Matthew D Harrington
- Division of Hospital Medicine, Department of Medicine, Mount Sinai Beth Israel, New York, New York
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74
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Pyoderma gangraenosum – from the right diagnostic investigations to targeted therapy. PHLEBOLOGIE 2016. [DOI: 10.12687/phleb2339-5-2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
SummaryPyoderma gangrenosum (PG) is a rarely diagnosed neutrophilic skin disorder that still remains a diagnosis of exclusion. Therefore, the diagnosis has to be done in the synopsis of typical clinical findings, patient’s history and exclusion of relevant differential diagnoses. There are numerous references to relevant comorbidities from the metabolic syndrome, rheumatoid arthritis and inflammatory bowel diseases. Of particular importance is the potential association of PG with (haematologic) neoplasms. Treatment of PG includes topical and systemic immuno-modulating or immuno-suppressant therapies. Most important are for topical as well as systemic treatments are glucocorticoids. All other treatments represent an off-label-use. Especially Cyclosporine and TNF-α-inhibitors demonstrated very good and promising clinical results. Accompanying modern moist wound-therapy concepts avoiding painful dressings and an analgesic therapy are recommended.
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75
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Abstract
Pyoderma gangrenosum (PG) is an unusual ulcerating cutaneous process frequently representing a dermatologic manifestation of a systemic disease including myeloproliferative disorders. This article describes the first case of PG associated with acute megakaryoblastic leukemia (AML-M7). This case determined that the morphology of blast forms present within the lesion represented by PG, including elongated cytoplasmic projections, frayed shaggy cytoplasm, and appearance of adhesion of blasts to each other, are suggestive, though not diagnostic, of megakaryoblast. Identification of microthrombi within PG, suggestion of adhesion of circulating megakaryoblasts, and previous reported cases of patients with AML-M7 and patients with PG associated with myeloproliferative disorders exhibiting thrombotic or coagulopathies suggest that a localized microangiopathic consumptive coagulopathy or microthrombotic ischemic process might be considered in the etiology and pathogenesis of PG.
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Affiliation(s)
- Byron E. Crawford
- Department ot Pathology and Laboratory Medicine, Tulane University School of Medicine, New Orleans, Louisiana
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76
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Pyoderma gangrenosum—a novel approach? Wien Med Wochenschr 2016; 167:58-65. [DOI: 10.1007/s10354-016-0472-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/30/2016] [Indexed: 12/20/2022]
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77
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Abstract
Pyoderma Gangrenosum is cutaneous manifestation of a systemic problem that should be systematically diagnosed and managed with care. When such lesions appear on legs, it is important to study and treat the systematic problem.
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Affiliation(s)
- Venk Mani
- Wigan and Leigh Healthcare Trusts, Greater Manchester, UK.
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78
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Dini V, Romanelli M, Bertone M, Talarico S, Bombardieri S, Barachini P. Improvement of Idiopathic Pyoderma Gangrenosum During Treatment With Anti-Tumor Necrosis Factor Alfa Monoclonal Antibody. INT J LOW EXTR WOUND 2016; 6:108-13. [PMID: 17558009 DOI: 10.1177/1534734607300912] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Pyoderma gangrenosum (PG) is an inflammatory ulcerative condition of unknown etiology. An autoimmune mechanism including immune complex—mediated neutrophilic vascular reactions has been suggested. The role of tumor necrosis factor (TNF) in PG remains unclear. Evidence supports the idea that TNF plays a role in chronic inflammation and migration of neutrophils to these lesions. PG is frequently associated with various diseases, but up to 50% of cases are idiopathic. There are several reports describing the successful use of infliximab™ (Remicade ® , Centocor, Inc, Horsham, Pa), a chimeric antitumor necrosis factor α monoclonal antibody, in the treatment of inflammatory bowel disease— associated PG, but there have been few reported cases of infliximab in the treatment of idiopathic PG. The authors present a dramatic improvement in 4 cases of idiopathic PG of the lower leg treated with infliximab.
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Affiliation(s)
- Valentina Dini
- Wound Healing Research Unit, Department of Dermatology, University of Pisa, Pisa, Italy
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79
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Freg GNI, Shah V, Nagral A, Jhaveri A. Pyoderma Gangrenosum-A New Manifestation of Wilson Disease? J Clin Exp Hepatol 2016; 6:62-4. [PMID: 27194899 PMCID: PMC4862012 DOI: 10.1016/j.jceh.2015.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 11/27/2015] [Indexed: 12/12/2022] Open
Abstract
Seventeen year old girl, a known case of Wilson disease presented to us with a non-healing skin ulcer followed by appearance of jaundice, ascites and progressive fatigue of 1 month duration. She was diagnosed to have Wilson disease 5 years back and had been well controlled on d-penicillamine. On enquiry, she was found to be noncompliant with her medication in the preceding 6 months. On examination, she had severe pallor, icterus with moderate ascites and oedema feet. Investigations revealed severe haemolytic anemia and deranged liver function. The lesion was diagnosed to be pyoderma gangrenosum on skin biopsy. The appearance of a cutaneous lesion followed by deterioration in the liver disease and hemolysis suggested uncontrolled Wilson disease as the triggering factor. Chelation therapy improved her haemoglobin and liver function as well as led to healing of the ulcer. We describe pyoderma gangrenosum as a new manifestation of Wilson disease.
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Affiliation(s)
| | - Venisha Shah
- Department of Dermatology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Aabha Nagral
- Department of Gastroenterology, Jaslok Hospital and Research Centre, Mumbai, India,Address for correspondence: Dr. Aabha Nagral, 7, Sneha Sagar, Prabhanagar, Prabhadevi, Mumbai 400 025, India. Tel.: +91 9820156834.7, Sneha Sagar, Prabhanagar, PrabhadeviMumbai400 025India
| | - Ajay Jhaveri
- Department of Gastroenterology, Jaslok Hospital and Research Centre, Mumbai, India
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80
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Anuset D, Reguiai Z, Perceau G, Colomb M, Durlach A, Bernard P. Caractéristiques cliniques et traitement du pyoderma gangrenosum dans la Marne. Ann Dermatol Venereol 2016; 143:108-17. [DOI: 10.1016/j.annder.2015.10.593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/15/2015] [Accepted: 10/28/2015] [Indexed: 11/28/2022]
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81
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Jha PK, Rana A, Kapoor S, Kher V. Pyoderma gangrenosum in a renal transplant recipient: A case report and review of literature. Indian J Nephrol 2015; 25:297-9. [PMID: 26628796 PMCID: PMC4588326 DOI: 10.4103/0971-4065.156900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pyoderma gangrenosum (PG) is a rare disorder of unknown etiology characterized by multiple cutaneous ulcers with mucopurulent or hemorrhagic exudate. This sterile neutrophilic dermatosis is known to occur in association with malignancy, infection, autoimmune disorders and drugs. Occurrence of PG in a renal transplant recipient, who is already on immunosuppressants, is rare. We hereby report a renal transplant recipient who developed PG 1-month after transplant and responded well to treatment with escalated dose of oral steroid.
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Affiliation(s)
- P K Jha
- Department of Nephrology, Medanta Institute of Kidney and Urology, Haryana, India
| | - A Rana
- Department of Pathology and Lab Medicine, Medanta - The Medicity, Gurgaon, Haryana, India
| | - S Kapoor
- Department of Dermatology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - V Kher
- Department of Nephrology, Medanta Institute of Kidney and Urology, Haryana, India
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82
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Affiliation(s)
| | - J M Crawley
- Consultant Dermatologist in the Department of Dermatology, University College London Hospital, London NW1 2BU
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83
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Androutsakos T, Stamopoulos P, Aroni K, Hatzis G. A case report of successful treatment of pyoderma gangrenosum in a patient with autoimmune hepatitis, and review of the literature. BMC Gastroenterol 2015; 15:149. [PMID: 26502871 PMCID: PMC4624371 DOI: 10.1186/s12876-015-0376-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/14/2015] [Indexed: 12/24/2022] Open
Abstract
Background Pyoderma Gangrenosum (PG) is a cutaneous condition, its diagnosis suggested by the presence of a painful cutaneous ulcer showing rapid progression. Pyoderma gangrenosum is associated with a concomitant systemic disease in 50 to 70 % of cases, including inflammatory bowel disease (IBD), rheumatoid arthritis, and lymphoproliferative disorders. Although PG has also been reported with viral hepatitis, it is rarely associated with autoimmune hepatitis. Case presentation A 19-year-old Caucasian female, with a prior diagnosis of autoimmune hepatitis (AIH) in remission, presented with bilateral lower limb ulcers 4 years after the diagnosis of AIH. She was diagnosed with PG and treated with high-dose prednisolone, methotrexate and cyclosporine. One year later she was well, the ulcers completely healed, and with the autoimmune hepatitis still in remission. Conclusion We report a case of autoimmune hepatitis and the subsequent, rarely occurring, extra-hepatic onset of pyoderma gangrenosum, with the AIH in remission, strengthening the association between the two conditions. Since both the AIH and the PG can present serious diagnostic challenges, thus delaying vital therapy, it is important that the development of either prompts us to consider the possibility of the other developing in the future or if already present facilitate its diagnosis, such considerations making the case for a systematic follow up.
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Affiliation(s)
- Theodoros Androutsakos
- Pathophysiology Department, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
| | - Paraskevas Stamopoulos
- Second Department of Propedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
| | - Kiriaki Aroni
- Department of Dermatopathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Gregorios Hatzis
- Pathophysiology Department, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
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84
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85
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Jockenhöfer F, Klode J, Kröger K, Roesch A, Al Ghazal P, Dissemond J. Patients with pyoderma gangrenosum - analyses of the German DRG data from 2012. Int Wound J 2015; 13:951-6. [PMID: 26250591 DOI: 10.1111/iwj.12463] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 04/19/2015] [Accepted: 04/20/2015] [Indexed: 11/28/2022] Open
Abstract
Pyoderma gangrenosum (PG) is a rarely diagnosed non-infectious neutrophil ulcerative dermatosis with only limited knowledge on the underlying auto-inflammatory process. To unravel common cofactors and comorbidities in patients with PG we analysed Diagnosis Related Groups (DRG) cases of all inpatients diagnosed with PG in German hospitals in 2012. We received data of 1227 inpatient cases having PG as primary diagnosis and 985 inpatient cases with PG as secondary diagnosis. The ratio of women to men was 2:1, and the most often registered age was 75-79 years. Common comorbidities were arterial hypertension (50·3%), non-insulin-dependent diabetes mellitus (25·1%) and dysfunction of lipid metabolism (10·8%). In sum, 94·8% of the patients suffered from aspects of metabolic syndrome. Other comorbidities were Crohn's disease (4·5%), ulcerative colitis (4·2%), chronic polyarthritis (5·2%), monoclonal gammopathy or myelodysplastic syndrome (2·5%), leukaemia (1·1%) and lymphoma (0·4%). DRG data do not reflect individual patients, but rather patient cases. We described the worldwide largest PG population and confirmed a wide range of potentially relevant and partly not yet described cofactors and comorbidities such as metabolic syndrome.
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Affiliation(s)
- Finja Jockenhöfer
- Department of Dermatology, Venerology and Allergology, University Hospital of Medicine, Essen, Germany
| | - Joachim Klode
- Department of Dermatology, Venerology and Allergology, University Hospital of Medicine, Essen, Germany
| | - Knut Kröger
- Department of Vascular Medicine, Helios Hospital, Krefeld, Germany
| | - Alexander Roesch
- Department of Dermatology, Venerology and Allergology, University Hospital of Medicine, Essen, Germany
| | - Philipp Al Ghazal
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University Hospital of Medicine, Essen, Germany.
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86
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Braswell SF, Kostopoulos TC, Ortega-Loayza AG. Pathophysiology of pyoderma gangrenosum (PG): an updated review. J Am Acad Dermatol 2015; 73:691-8. [PMID: 26253362 DOI: 10.1016/j.jaad.2015.06.021] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/05/2015] [Accepted: 06/10/2015] [Indexed: 12/11/2022]
Abstract
Pyoderma gangrenosum is a challenging skin condition to identify and treat because of its multifactorial pathogenesis. It is a rare cutaneous manifestation diagnosed clinically by exclusion of infection, neoplasia, thrombophilia, and other inflammatory conditions. Pathogenetic and treatment studies are scarce. Abnormalities in the function of inflammatory cytokines, the immune system, and neutrophils combined with specific genetic mutations predispose patients to develop this complex disease process. Early recognition of patients at risk for pyoderma gangrenosum, the necessity to improve its early diagnosis, and the future outlook of targeted and personalized therapies relies on the improved comprehension of the complex pathogenesis of pyoderma gangrenosum.
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Affiliation(s)
- Sara F Braswell
- Department of Dermatology, Virginia Commonwealth University, Richmond, Virginia
| | | | - Alex G Ortega-Loayza
- Department of Dermatology, Virginia Commonwealth University, Richmond, Virginia.
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87
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Wallach D, Vignon-Pennamen MD. Pyoderma gangrenosum and Sweet syndrome: the prototypic neutrophilic dermatoses. Br J Dermatol 2015. [PMID: 26202386 DOI: 10.1111/bjd.13955] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Pyoderma gangrenosum, a dramatic ulcerative skin disease, and Sweet syndrome, a papular dermatosis, were described independently. It was subsequently shown that they share many characteristics, including clinical overlap and the frequent association with multisystemic disorders. The group of the neutrophilic dermatoses encompasses these two dermatoses, as well as other conditions having in common an aseptic neutrophilic infiltrate predominating in the epidermis and/or the dermis and/or the subcutis. Some patients also experience neutrophilic infiltrates in other organs, defining the neutrophilic disease. Recent research suggests that the neutrophilic dermatoses could be considered as the cutaneous expression of the autoinflammation, an aberrant hyperproduction of interleukin-1. Autoinflammation is responsible for monogenic diseases, and is also involved in the mechanism of many polygenic conditions, including the neutrophilic dermatoses.
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Affiliation(s)
- D Wallach
- Médecin (hon). des Hôpitaux, Paris, France
| | - M-D Vignon-Pennamen
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1165, F-75010, Paris, France.,INSERM, U1165, F-75010, Paris, France.,Laboratoire de Pathologie, Hôpital Saint-Louis, AP-HP, F-75010, Paris, France
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88
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Kozono K, Nakahara T, Kikuchi S, Itoh E, Kido-Nakahara M, Furue M. Pyoderma gangrenosum with increased levels of serum cytokines. J Dermatol 2015; 42:1186-8. [PMID: 26047254 DOI: 10.1111/1346-8138.12970] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 04/24/2015] [Indexed: 11/30/2022]
Abstract
A 66-year-old woman presented after an episode of accidental trauma with a painful ulcer on her scalp which rapidly enlarged in size, accompanied by central necrosis and undermining ulceration. The patient's past history was negative for underlying systemic disease, although she had had a similar post-traumatic intractable leg ulcer 3 years prior, which was unresponsive to surgical management but successfully treated with systemic steroids. A biopsied specimen from the scalp showed marked neutrophilic infiltrates in the dermis, compatible with a diagnosis of pyoderma gangrenosum (PG). The large ulcerative lesion responded very well to oral steroid therapy, showing rapid epithelialization. Serum levels of granulocyte colony-stimulating factor and interleukin-6 were significantly elevated prior to treatment, with decrease to normal levels after treatment. Serum tumor necrosis factor (TNF)-α and granulocyte macrophage colony-stimulating factor levels were within normal limits. The significance and pathogenic role of cytokine burst in PG is reviewed and discussed.
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Affiliation(s)
- Kana Kozono
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Nakahara
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Division of Skin Surface Sensing, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoko Kikuchi
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Dermatology, Kyushu Central Hospital, Fukuoka, Japan
| | - Eriko Itoh
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Division of Skin Surface Sensing, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Makiko Kido-Nakahara
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masutaka Furue
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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89
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Hurabielle C, Schneider P, Baudry C, Bagot M, Allez M, Viguier M. Certolizumab pegol - A new therapeutic option for refractory disseminated pyoderma gangrenosum associated with Crohn's disease. J DERMATOL TREAT 2015; 27:67-9. [PMID: 25909366 DOI: 10.3109/09546634.2015.1034075] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Systemic steroids, in association or not with cyclosporin, are indicated for the treatment of large or widespread Pyoderma gangrenosum (PG). We report the case of a 27-year-old woman with a 15-year history of severe Crohn's disease, who developed a severe and disseminated PG, refractory to multiple lines of treatment. Infliximab and adalimumab were contraindicated, either because of allergy or of ineffectiveness on Crohn's disease. The addition of certolizumab pegol to the baseline treatment, associating systemic steroids and tacrolimus, finally allowed the complete healing of PG. Oral prednisone was stopped and tacrolimus was decreased, without any cutaneous or digestive relapse. Certolizumab pegol could be an alternative therapy in the treatment of PG in case of intolerance or ineffectiveness of the other anti-tumor necrosis factor (anti-TNF) therapies.
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Affiliation(s)
- Charlotte Hurabielle
- a Department of Dermatology , Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (APHP) , Paris , France
| | - Pierre Schneider
- a Department of Dermatology , Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (APHP) , Paris , France .,b Université Paris Diderot , Sorbonne Paris Cité , Paris , France , and
| | - Clotilde Baudry
- b Université Paris Diderot , Sorbonne Paris Cité , Paris , France , and.,c Department of Gastroenterology , Hôpital Saint-Louis , APHP , Paris , France
| | - Martine Bagot
- a Department of Dermatology , Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (APHP) , Paris , France .,b Université Paris Diderot , Sorbonne Paris Cité , Paris , France , and
| | - Matthieu Allez
- b Université Paris Diderot , Sorbonne Paris Cité , Paris , France , and.,c Department of Gastroenterology , Hôpital Saint-Louis , APHP , Paris , France
| | - Manuelle Viguier
- a Department of Dermatology , Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (APHP) , Paris , France .,b Université Paris Diderot , Sorbonne Paris Cité , Paris , France , and
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90
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Radhika AG, Singal A, Radhakrishnan G, Singh S. Pyoderma gangrenosum following a routine caesarean section: Pseudo-infection in a caesarean wound. Qatar Med J 2015; 2015:1. [PMID: 26535169 PMCID: PMC4614332 DOI: 10.5339/qmj.2015.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 12/11/2014] [Indexed: 12/04/2022] Open
Abstract
A 22-year-old booked primigravida underwent lower segment caesarean section for breech presentation. She developed signs and symptoms of wound infection by the fourth postoperative day. This was initially managed with antibiotics and wound dressing, but debridement was later undertaken after consulting surgeons. This resulted in an alarming worsening of the wound with sudden and fast increase in its size along with systemic symptoms. Wound biopsy established the diagnosis of pyoderma gangrenosum. The patient's management included oral medication with prednisolone, cyclosporin and dapsone and wound care. There was a dramatic response to this treatment. The wound completely healed by the eighth postoperative month. The oral medications were tapered off slowly and stopped by that time.
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Affiliation(s)
- A G Radhika
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Archana Singal
- Department of Dermatology and Venereology, University College of Medical Sciences and Guru Teg Bahadur Hospital Delhi, India
| | - Gita Radhakrishnan
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Smita Singh
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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91
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Ghazal PA, Dissemond J. Therapie des Pyoderma gangraenosum in Deutschland: Resultate einer Befragung von Experten. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.12585_suppl] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Philipp Al Ghazal
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen
| | - Joachim Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
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92
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Al Ghazal P, Dissemond J. Therapy of pyoderma gangrenosum in Germany: results of a survey among wound experts. J Dtsch Dermatol Ges 2015; 13:317-24. [DOI: 10.1111/ddg.12585] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Philipp Al Ghazal
- Department of Dermatology, Venereology and Allergology; University Medicine Göttingen
| | - Joachim Dissemond
- Department and outpatient clinic of Dermatology; Venereology and Allergology, University Hospital Essen
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93
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Weizman AV, Huang B, Targan S, Dubinsky M, Fleshner P, Kaur M, Ippoliti A, Panikkath D, Vasiliauskas E, Shih D, McGovern DPB, Melmed GY. Pyoderma Gangrenosum among Patients with Inflammatory Bowel Disease: A Descriptive Cohort Study. J Cutan Med Surg 2015; 19:125-31. [PMID: 25775631 DOI: 10.2310/7750.2014.14053] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pyoderma gangrenosum (PG) is a severe extraintestinal manifestation of inflammatory bowel disease (IBD). OBJECTIVE To better characterize PG features and management among an IBD cohort. METHODS Subjects with PG were identified using a large database at a tertiary center. Patient demographics and clinical characteristics were summarized using descriptive statistics. RESULTS Eighty patients with an episode(s) of PG were identified, yielding an overall prevalence of 1.9%. Overall, 93% of patients with PG had some degree of colonic inflammation. Thirty-one (39%) patients required hospitalization for PG. Underlying bowel disease was active at the time of PG episode(s) in 52 (65%) patients. The PG location was variable, with the lower extremity being the most common. Most patients (71.3%) required multiple therapies to achieve PG healing. CONCLUSIONS We describe one of the largest case series of PG among patients with IBD. The variety of treatment strategies used highlights the lack of clear guidelines in managing this complex group of patients.
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Affiliation(s)
- Adam V Weizman
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Brian Huang
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Stephan Targan
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Marla Dubinsky
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Phillip Fleshner
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Manreet Kaur
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Andrew Ippoliti
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Deepa Panikkath
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Eric Vasiliauskas
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - David Shih
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Dermot P B McGovern
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Gil Y Melmed
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
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94
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Ozuguz P, Kacar SD, Manav V, Karaca S, Aktepe F, Ulu S. Genital Ulcerative Pyoderma Gangrenosum in Behçet's Disease: A Case Report and Review of the Literature. Indian J Dermatol 2015; 60:105. [PMID: 25657430 PMCID: PMC4318036 DOI: 10.4103/0019-5154.147866] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Behçet's disease (BD), first described by Hulusi Behcet, is a multisystemic disease characterized by recurrent oral and genital ulcerations, ocular and cutaneous lesions, arthritis and vascular disease. Pyoderma gangrenosum (PG) is a rare, chronic, sterile pustular and progressive ulcerative process of unknown cause; sometimes can participate in the differential diagnosis of Behcet's ulceration. A 33-year-old woman complained a severe genital ulcer. She had a purulent oozing and stinky ulceration on the right side of labium minor measuring 5-8 cm. A punch biopsy at ulcer margin showed that the lymphocytic panniculitis was extending to the subcutaneous fat tissue without fibrin deposition or necrotic changes in the vessel wall. Based on the clinical and histological findings, she was diagnosed as genital ulcerative PG, which occurred during the exacerbation of BD.
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Affiliation(s)
- Pinar Ozuguz
- Afyon Kocatepe University Department of Dermatology, Afyon, Turkey
| | | | - Vildan Manav
- Afyon Kocatepe University Department of Dermatology, Afyon, Turkey
| | - Semsettin Karaca
- Afyon Kocatepe University Department of Dermatology, Afyon, Turkey
| | - Fatma Aktepe
- Department of Pathology, Afyon Kocatepe University Dermatology, Afyon, Turkey
| | - Sena Ulu
- Department of Nephrology, Afyon Kocatepe University Dermatology, Afyon, Turkey
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95
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Johnson JL, West DA, Haggstrom AN. Pyoderma gangrenosum associated with an aseptic splenic abscess in a patient with neurofibromatosis. Pediatr Dermatol 2015; 32:113-7. [PMID: 23535023 DOI: 10.1111/pde.12129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pyoderma gangrenosum (PG) is a painful, ulcerating neutrophilic dermatosis commonly associated with a variety of underlying systemic conditions. We report a child with neurofibromatosis-1 (NF-1) and an aseptic splenic abscess who developed multifocal PG in areas of iatrogenic skin trauma. There is no clinical evidence or theoretical basis to suggest a causal relationship between NF-1 and PG. Systemic corticosteroid and cyclosporine therapy led to complete resolution of the lesions.
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Affiliation(s)
- Jamie L Johnson
- Indiana University School of Medicine, Indianapolis, Indiana
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96
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Sakata KK, Penupolu S, Colby TV, Gotway MB, Wesselius LJ. Pulmonary pyoderma gangrenosum without cutaneous manifestations. CLINICAL RESPIRATORY JOURNAL 2014; 10:508-11. [DOI: 10.1111/crj.12240] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 10/14/2014] [Accepted: 10/27/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Kenneth Kazuto Sakata
- Department of Internal Medicine; Division of Pulmonary Medicine; Mayo Clinic Arizona; Scottsdale AZ USA
| | - Sudheer Penupolu
- Department of Internal Medicine; Division of Pulmonary Medicine; Mayo Clinic Arizona; Scottsdale AZ USA
| | - Thomas Vail Colby
- Department of Laboratory Medicine and Pathology; Division of Anatomic Pathology; Mayo Clinic Arizona; Scottsdale AZ USA
| | | | - Lewis Jon Wesselius
- Department of Internal Medicine; Division of Pulmonary Medicine; Mayo Clinic Arizona; Scottsdale AZ USA
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97
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Mercer JM, Kuzel P, Mahmood MN, Brassard A. Fatal Case of Vulvar Pyoderma Gangrenosum with Pulmonary Involvement: Case Presentation and Literature Review. J Cutan Med Surg 2014; 18:424-9. [DOI: 10.2310/7750.2014.13196] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: We report a case of a 61-year-old woman with locally destructive vulvar pyoderma gangrenosum (PG) with pulmonary involvement who was refractory to numerous systemic therapies and developed complications resulting in her demise. Objective: To report a rare case of treatment-resistant vulvar PG with pulmonary involvement that proved to be fatal. Methods: PubMed was used to search for other reports that discuss PG, or more specifically perigenital PG, with pulmonary involvement. Results and Conclusion: A thorough review of the literature revealed 33 cases of PG with pulmonary involvement, with only 4 involving the perigenital region. We report the second case of a female with vulvar PG and pulmonary involvement. In contrast to the first case described, our patient did not respond to systemic therapy, and, ultimately, her disease was fatal. It is hoped that with continued documentation of this rare and potentially lethal presentation of PG, physicians will determine more effective treatments.
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Affiliation(s)
- Joshua M. Mercer
- From the Division of Dermatology, Faculty of Medicine & Dentistry, University of Alberta, and Division of Anatomical Pathology, Department of Laboratory Medicine & Pathology, University of Alberta Hospital, Edmonton, AB
| | - Paul Kuzel
- From the Division of Dermatology, Faculty of Medicine & Dentistry, University of Alberta, and Division of Anatomical Pathology, Department of Laboratory Medicine & Pathology, University of Alberta Hospital, Edmonton, AB
| | - Muhammad N. Mahmood
- From the Division of Dermatology, Faculty of Medicine & Dentistry, University of Alberta, and Division of Anatomical Pathology, Department of Laboratory Medicine & Pathology, University of Alberta Hospital, Edmonton, AB
| | - Alain Brassard
- From the Division of Dermatology, Faculty of Medicine & Dentistry, University of Alberta, and Division of Anatomical Pathology, Department of Laboratory Medicine & Pathology, University of Alberta Hospital, Edmonton, AB
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98
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González-Moreno J, Ruíz-Ruigomez M, Callejas Rubio JL, Ríos Fernández R, Ortego Centeno N. Pyoderma gangrenosum and systemic lupus erythematosus: a report of five cases and review of the literature. Lupus 2014; 24:130-7. [PMID: 25199808 DOI: 10.1177/0961203314550227] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Pyoderma gangrenosum (PG) is an uncommon, distinctive cutaneous ulceration which is usually idiopathic, but may be associated with many systemic disorders. The etiopathogenesis of PG is still not well understood. PG is part of the spectrum of the neutrophilic dermatoses and it has been proposed as a prototype of cutaneous autoinflammatory disease. PG usually has a good outcome under immunosuppressive treatment. Although PG has been associated with several systemic diseases, it has rarely been reported in association with systemic lupus erythematosus (SLE). In this article we report five cases of SLE-related PG and review the literature. Our findings support the possible relationship between active SLE and PG, although the mechanism remains unclear. Clinical manifestations, used treatments and outcomes of SLE-related PG do not differ from the described for the general population.
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Affiliation(s)
- J González-Moreno
- Internal Medicine Department, Hospital Son Llàtzer, Spain Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Spain
| | - M Ruíz-Ruigomez
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Spain
| | - J L Callejas Rubio
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Spain
| | - R Ríos Fernández
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Spain
| | - N Ortego Centeno
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Spain
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99
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Yari SS, Reichel LM. Case report: misdiagnosed olecranon bursitis: pyoderma gangrenosum. J Shoulder Elbow Surg 2014; 23:e207-11. [PMID: 25127910 DOI: 10.1016/j.jse.2014.06.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 06/12/2014] [Indexed: 02/01/2023]
Affiliation(s)
| | - Lee M Reichel
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA.
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100
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Pyoderma gangrenosum: Intractable leg ulcers in Sjogren's syndrome. Kaohsiung J Med Sci 2014; 30:486-8. [DOI: 10.1016/j.kjms.2013.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 11/19/2013] [Indexed: 11/20/2022] Open
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